Specific Etiologies Associated With the Multiple Organ Dysfunction Syndrome in Children: Part 1

Abstract

Objective: To describe a number of the conditions associated with multiple organ dysfunction syndrome presented as part of the Eunice Kennedy Shriver National Institute of Child Health and Human Development multiple organ dysfunction syndrome workshop (March 26-27, 2015).

Data sources: Literature review, research data, and expert opinion.

Study selection: Not applicable.

Data extraction: Moderated by an expert from the field, issues relevant to the association of multiple organ dysfunction syndrome with a variety of conditions were presented, discussed, and debated with a focus on identifying knowledge gaps and research priorities.

Data synthesis: Summary of presentations and discussion supported and supplemented by the relevant literature.

Conclusions: There is a wide range of medical conditions associated with multiple organ dysfunction syndrome in children. Traditionally, sepsis and trauma are the two conditions most commonly associated with multiple organ dysfunction syndrome both in children and adults. However, there are a number of other pathophysiologic processes that may result in multiple organ dysfunction syndrome. In this article, we discuss conditions such as cancer, congenital heart disease, and acute respiratory distress syndrome. In addition, the relationship between multiple organ dysfunction syndrome and clinical therapies such as hematopoietic stem cell transplantation and cardiopulmonary bypass is also considered. The purpose of this article is to describe the association of multiple organ dysfunction syndrome with a variety of conditions in an attempt to identify similarities, differences, and opportunities for therapeutic intervention.

Figure 1

Relationship between the systemic inflammatory response syndrome (SIRS), the multiple organ dysfunction syndrome (MODS) and three septic states (sepsis, severe sepsis and septic shock).

Figure 2. Pediatric Acute Respiratory Distress Definition

¹Use PaO₂-based metric when available. If PaO₂ is not available, wean FiO₂ to maintain SpO₂ ≤ 97% to calculate the SpO₂/FiO₂ (SF) ratio or the oxygen saturation index (OSI) where $$\text{OSI}=\frac{({\text{FiO}}_2\times \text{mean}\text{airway}\text{pressure}\times 100)}{{\text{SpO}}_{2.}}$$ ² Non-intubated patients treated with supplemental oxygen or nasal modes of noninvasive ventilation are categorized using the “at-risk” definition. ³Acute respiratory distress syndrome severity stratification based on OSI or oxygenation index (OI) where $$\text{OI}=\frac{({\text{FiO}}_2\times \text{mean}\text{airway}\text{pressure}\times 100)}{{\text{SpO}}_2}$$ should not be applied to children with chronic lung disease who normally receive invasive mechanical ventilation or children with cyanotic congenital heart disease. CPAP = continuous positive airway pressure, PF = PaO₂/FiO₂. Taken from: Khemani RG, Smith LS, Zimmerman JJ, Erickson S; Pediatric Acute Lung Injury Consensus Conference Group. Pediatric acute respiratory distress syndrome: definition, incidence, and epidemiology: proceedings from the Pediatric Acute Lung Injury Consensus Conference. Pediatr Crit Care Med. 2015;16:428–439 (Figure 2).